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Geier TJ, Timmer-Murillo SC, Brandolino AM, Piña I, Harb F, deRoon-Cassini TA. History of Racial Discrimination by Police Contributes to Worse Physical and Emotional Quality of Life in Black Americans After Traumatic Injury. J Racial Ethn Health Disparities 2024; 11:1774-1782. [PMID: 37249827 PMCID: PMC10228454 DOI: 10.1007/s40615-023-01649-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Black Americans are more likely than their White counterparts to experience traumatic injury and worse functional outcomes. Unfair police treatment has been identified as one specific form of racial discrimination potentially driving these deleterious outcomes. The aim of the investigation was to better understand the relationship between experiences of discrimination by police and trauma-specific quality of life outcomes, including PTSD symptom severity, in Black Americans following traumatic injury. METHOD Traumatically injured Black American adults (N = 53) presenting to a level 1 trauma center completed a measure of police and law enforcement discrimination at baseline, and quality of life and PTSD were assessed 6 months later. RESULTS Stepwise regressions results showed more frequent discrimination by police and law enforcement significantly predicted lower emotional and physical well-being 6 months after injury. Further, more frequent police discrimination resulted in more severe PTSD symptoms by 6 months after injury. CONCLUSIONS Findings underscore that following an injury not specifically related to discrimination by police, patients' historical, negative police experiences contributed to worse physical and emotional recovery in the present. These findings, in unison with prior investigations, reveal the need to consider patients' history of negative police experiences as a social determinant of health in their recovery.
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Affiliation(s)
- Timothy J Geier
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Sydney C Timmer-Murillo
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Amber M Brandolino
- Comprehensive Injury Center, Division of Data Surveillance and Informatics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Isela Piña
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Farah Harb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Comprehensive Injury Center, Division of Data Surveillance and Informatics, Medical College of Wisconsin, Milwaukee, WI, USA
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Jones EV, Bourgois P, Song JS, Chong VE. "You Have to Be a Doctor First": Trauma Surgeons' Perspectives on Police Interactions in the Hospital. Am Surg 2024:31348241250037. [PMID: 38703056 DOI: 10.1177/00031348241250037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Police activity in emergency medical settings has been shown to complicate the care of patients and impact patient-provider relationships. Recent scholarship has called for clear hospital policy outlining the terms of police access to patients and the role of clinicians. Despite regular contact between trauma surgeons and police, research on the impact of police activity on trauma care has been limited. METHODS Semi-structured interviews were conducted with attending trauma surgeons and general surgery residents (N = 13) at 3 urban hospitals about their interactions with police in clinical settings. Participants were recruited using snowball sampling. Interviews were audio-recorded, transcribed, and analyzed for recurrent themes using an iterative grounded theory process. RESULTS Participants reported routine contact with police that required active negotiation of the scope of clinical and police authority in the hospital. These negotiations were shaped by prior experiences, perceptions of police, officer behavior, and institutional culture. Surgeons felt compelled to advocate for patients, but reported intimidation in moments of conflict. Participants noted uncertainty around the legal dimensions of their relationship to police and a lack of universal guidance on appropriate responses. DISCUSSION This data points to the need for improvements in both policy and workflow to regulate and reduce the burden of these interactions and protect clinicians' priorities from being subordinated to those of police. Further research is needed to understand how police presence impacts patient outcomes, and to guide best practices for regulating and mitigating potential negative impact.
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Affiliation(s)
- Emily V Jones
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ji Seon Song
- University of California, Irvine School of Law, Irvine, CA, USA
| | - Vincent E Chong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA
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Wardrop R, Ranse J, Crilly J, Stubbs N, Chaboyer W. Clinicians' experiences of caring for people brought in by police to the emergency department: A qualitative interpretive study. J Adv Nurs 2024; 80:1955-1966. [PMID: 37994190 DOI: 10.1111/jan.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
AIM To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED). DESIGN A qualitative interpretive study using in-depth individual interviews. METHODS Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis. RESULTS Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay. CONCLUSION The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes. IMPLICATIONS FOR THE PROFESSION Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation. IMPACT This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes. REPORTING METHOD This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION This study focused on ED staff experiences.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Centre for Mental Health, Griffith University, Southport, Queensland, Australia
| | - Nicole Stubbs
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Chao S, Weber W, Iserson KV, Goett R, Baker EF, McGuire SS, Bissmeyer P, Derse AR, Kumar N, Brenner JM. Best practice guidelines for evaluating patients in custody in the emergency department. J Am Coll Emerg Physicians Open 2024; 5:e13143. [PMID: 38524358 PMCID: PMC10960077 DOI: 10.1002/emp2.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Patients in custody due to arrest or incarceration are a vulnerable population that present a unique ethical and logistical challenge for emergency physicians (EPs). People incarcerated in the United States have a constitutional right to health care. When caring for these patients, EPs must balance their ethical obligations to the patient with security and safety concerns. They should refer to their institutional policy for guidance and their local, state, and federal laws, when applicable. Hospital legal counsel and risk management also can be helpful resources. EPs should communicate early and openly with law enforcement personnel to ensure security and emergency department staff safety is maintained while meeting the patient's medical needs. Physicians should consider the least restrictive restraints necessary to ensure security while allowing for medical evaluation and treatment. They should also protect patient privacy as much as possible within departmental constraints, promote the patient's autonomous medical decision-making, and be mindful of ways that medical information could interact with the legal system.
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Affiliation(s)
- Samantha Chao
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
| | - William Weber
- Department of Emergency MedicineRush UniversityChicagoIllinoisUSA
| | - Kenneth V. Iserson
- Department of Emergency MedicineThe University of ArizonaTucsonArizonaUSA
| | - Rebecca Goett
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | | | | | - Paul Bissmeyer
- Department of Emergency MedicineOrange Park HospitalJacksonvilleFloridaUSA
| | - Arthur R. Derse
- Center for Bioethics and Medical Humanities and Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Nishi Kumar
- College of LawLoyola University New OrleansNew OrleansLouisianaUSA
| | - Jay M. Brenner
- Department of Emergency MedicineSUNY‐Upstate Medical UniversitySyracuseNew YorkUSA
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Roman CG. A Conceptual Model of Help-Seeking by Black Americans After Violent Injury: Implications for Reducing Inequities in Access to Care. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:95-107. [PMID: 36040620 PMCID: PMC11127842 DOI: 10.1007/s11121-022-01429-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
Many inequities exist in serving and supporting Black survivors of violent crime. A key question in reducing inequities in care after victimization is whether police first responders and other formal system providers identify the victim as an "offender" and/or someone who is "undeserving" of supports. These labels and associated biases can directly reduce access to supports through a variety of mechanisms that include police withholding information about one's rights as a victim, among other direct and indirect barriers to social and health services. Unaddressed financial, mental, and physical health consequences of victimization contribute to poorer health outcomes later in life. This paper seeks to bring together the extant research on help-seeking, discrimination in criminal legal system functioning, and barriers to victim services by synthesizing these discrete threads into a theoretically and empirically informed conceptual model that captures the range of factors that shape Black Americans' decision to report their victimization to the police and subsequent help-seeking. Qualitative and quantitative data from a purposive sample of 91 Black victims of community violence is used to ground the developing model. The conceptual model can help lay the foundation for research that seeks to remedy the marked mismatch between the prevalence of violent victimization and help-seeking among Black Americans. Research findings can be applied to guide policies and programming to reduce inequities in care for victims of violence.
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Affiliation(s)
- Caterina G Roman
- Department of Criminal Justice, Temple University, 1115 Polett Walk, 5th Fl Gladfelter Hall, Philadelphia, PA, USA.
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Barnett H, Taylor Z, Booker L, Ricklefs C, Veltri K, Ervin DV, Gimarc K, Adedipe A. Training Among Noncustodial Health Care Workers Caring for Patients Experiencing Incarceration: A Preliminary Investigation. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:411-420. [PMID: 37917880 DOI: 10.1089/jchc.22.11.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
People experiencing incarceration in the United States receive much of their health care outside of custodial settings. Optimizing care in this setting requires further understanding of the training and experiences of noncustodial health care workers. We conducted a cross-sectional, exploratory survey of health care workers at a single academic institution to assess their training and experiences related to caring for this patient population. Of 333 respondents, 94.1% had cared for patients experiencing incarceration but only 22.5% had received any formal training, with 94.6% somewhat or very interested in further training. Common challenges included lack of privacy, difficulty obtaining patient history or completing an examination, and patient distress. Health care workers frequently experience challenges and report strong interest in further training to address knowledge gaps, and further detailed investigation is needed.
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Affiliation(s)
- Heather Barnett
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Zoe Taylor
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Lyndsey Booker
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Colbey Ricklefs
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kami Veltri
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Kayli Gimarc
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Adeyinka Adedipe
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
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Lamneck C, Alvarez A, Zaragoza C, Rahimian R, Trejo MJ, Lebensohn P. Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border. Int J Equity Health 2023; 22:199. [PMID: 37770859 PMCID: PMC10540385 DOI: 10.1186/s12939-023-01934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Over the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting. METHODS This cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants' experience caring for patients in ILE custody, including the perception of respect, violations of patients' privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments. RESULTS 332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees' medical care, detainees' privacy rights, or ILE's authority in patient care. CONCLUSIONS This study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.
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Affiliation(s)
- Claire Lamneck
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | | | | | - Mario Jesus Trejo
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Wells JM, Walker VP. "Do No Harm": Promoting Anti-Racist Policing in Pediatric Emergency Departments Through 20 Practice Change Considerations. Health Promot Pract 2023; 24:406-410. [PMID: 36648067 DOI: 10.1177/15248399221145160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children represent some of the most vulnerable and most valuable members of society. When acutely ill or injured, pediatric emergency departments (EDs) provide first line, specialized care for children and adolescents. Unique and unpredictable, the pediatric ED environment requires a wide range of health care professionals to care for children and their families and often includes hospital-employed security professionals and local law enforcement personnel to ensure safe and protective spaces paramount for optimal patient care. However, an active policing presence within environments designed to promote healing can paradoxically contribute to harm, particularly for Black and Brown patients. As health care systems pledge to dismantle structural racism and achieve health equity, efforts must include anti-racist reforms of threat management systems within clinical environments. We propose assessment and evaluation of current security and police encounters within pediatric EDs. We call for institution of policies that mitigate biases, address medical mistrust, distinguish clinical from criminal aggression, and minimize punitive contact with police. We outline a multitiered, patient-centered approach to disruptive and violent acts that prioritizes prevention, early intervention, and de-escalation strategies with a goal of reducing the perceived need for policing presence in pediatric EDs.
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Affiliation(s)
- Jordee M Wells
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Valencia P Walker
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
- University of California, Los Angeles, Los Angeles, CA, USA
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9
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Schultz ML, Winn M, Derse AR, Kaczor F, Levas MN. Interactions With Police in the Emergency Care of Children: Ethical and Legal Considerations. Pediatr Emerg Care 2023; 39:226-229. [PMID: 36727807 PMCID: PMC10082052 DOI: 10.1097/pec.0000000000002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Emergency medicine providers may interface with law enforcement personnel (LEP) on behalf of their pediatric patients for a variety of reasons, from reporting child abuse to caring for children who are in police custody. Given the unique nature of caring for minors who may not have legal or medical autonomy, interactions with LEP can raise ethical concerns for emergency providers, specifically with regard to legal representation, developmental immaturity, and the civil rights of children and their parents/guardians. METHODS We review 4 patient scenarios, based on real cases experienced by the authors, to demonstrate the legal and ethical issues that may arise when LEP are involved in the emergency care of a child. These scenarios discuss parental/guardian visitation for children in police custody in the emergency department (ED), the practice of making arrests on hospital grounds, and police interviews of children in the ED. RESULTS Using the ethical principles of autonomy, beneficence, and justice, we offer recommendations for emergency providers on how to advocate for their pediatric patients in LEP custody within the constraints and protections of the law. We also suggest best practices for hospital systems to develop policies surrounding LEP activity in the ED. CONCLUSIONS These nuanced situations require careful advocacy for the child and a collaborative approach between medical providers and LEP to balance the child's well-being with public safety. We offer recommendations here, and we maintain that clear, widely adopted best practices for the care of minors in LEP custody are long overdue.
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Affiliation(s)
- Megan L. Schultz
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
| | - Madeline Winn
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
| | - Arthur R. Derse
- Department of Emergency Medicine, Medical College of Wisconsin
| | | | - Michael N. Levas
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
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Kaufman EJ, Khatri U, Hall EC, Alur R, Song J, Beard JH, Jacoby SF. Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma. Trauma Surg Acute Care Open 2023; 8:e001022. [PMID: 36937171 PMCID: PMC10016311 DOI: 10.1136/tsaco-2022-001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Background Trauma patients frequently come into contact with law enforcement officers (LEOs) during the course of their medical care, but little is known about how LEO presence affects processes of care. We surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of LEO presence in trauma bays nationwide. Methods Survey items addressed respondents' experience with the frequency and context of LEO presence and their perspectives on the impact of LEO presence for patients, clinical care, and public safety. Respondent demographics, professional characteristics, and practice setting were collected. The survey was distributed electronically to AAST members in September and October of 2020. Responses were compared by participant age, gender, race, ethnicity, urban versus rural location using χ2 tests. Results Of 234 respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEO presence was most helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents regarding the impact on patients, clinical care, and public safety (p<0.001 across all domains). When determining LEO access, respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety. Conclusions Respondents described a wide range of perspectives on the impact and consequence of LEO in the trauma bay, with little policy to guide interactions. The overlap of law enforcement and healthcare in the trauma bay deserves attention from institutional and professional policymakers to preserve patient safety and autonomy and patient-centered care. Level of evidence IV, survey study.
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Affiliation(s)
- Elinore J Kaufman
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Utsha Khatri
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Erin C Hall
- Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rucha Alur
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jamie Song
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jessica H Beard
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sara F Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Schroeder ME, Brandolino A, Williams K, McIntosh B, Pilarski AM, Milia DJ, deRoon-Cassini T. Addressing the educational gap in the role of law enforcement personnel in the resuscitation bay. Surgery 2023; 173:804-811. [PMID: 36272772 DOI: 10.1016/j.surg.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Health care workers are often uncertain of the role of law enforcement personnel in the resuscitation bay. A cross-sectional, quality improvement project was designed with an educational intervention to address the knowledge gaps. METHODS There were 2 sessions for trauma surgery and emergency medicine faculty, residents, and staff. The first was a formal presentation by hospital risk management and security focused on answering questions generated by real-life scenarios. After reviewing feedback from the first session, the second session was designed as a panel discussion led by attending physicians who reviewed various clinical scenarios. A pre/postsurvey was administered, including potential clinical scenarios with multiple-choice answers and open feedback. RESULTS There were 64 presurvey and 31 postsurvey respondents from the first session (48.4%). Significantly more questions were answered correctly from pre to postsurvey (5.5 vs 6.7/16 questions; U = 798.0, P = .048). Of the 14 (45.2%) respondents who provided open-ended feedback, 50% indicated confusion, and 21.4% expressed strong, negative emotions. In the second session, there were 39 presurvey and 18 postsurvey respondents (46.2%). Again, significantly more questions were answered correctly after the second session (2.2 vs 4.5/7 questions; U = 115.0, P ≤ .001). Feedback highlighted that the panel format was considered more helpful than the formal didactic of the first session. CONCLUSION Confusion about the role of law enforcement personnel in the clinical environment can be partially addressed using multidisciplinary joint conferences that should be led by clinicians to ensure real-life clinical applicability. Further education and law enforcement personnel role clarification for health care workers are critical to protect patient rights.
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Affiliation(s)
- Mary E Schroeder
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Amber Brandolino
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/AmberBrandolino
| | - Kathleen Williams
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/kshwilliamsmd
| | - Brady McIntosh
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/grimsley20
| | - Alicia M Pilarski
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/apilar33
| | - David J Milia
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Terri deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI; Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI
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12
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Gallen KM, Smith MJ, Crane J, Loughran C, Schuster K, Sonnenberg J, Reese M, Girard VW, Song JS, Hall EC. Law Enforcement and Patient Privacy Among Survivors of Violence: A Nationwide Mixed-Methods Study. J Surg Res 2023; 283:648-657. [PMID: 36455418 DOI: 10.1016/j.jss.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION During the emergent treatment of violently injured patients, law enforcement (LE) officers and health care providers frequently interact. Both have duties to protect patient health, rights, and public health, however, the balance of these duties may feel at odds. The purpose of this study is to assess hospital-based violence intervention program (HVIP) representatives' experiences with LE officers among survivors of violence and the impact of hospital policies on interactions with LE officers. MATERIALS AND METHODS A nationwide survey was distributed to the 35 HVIPs that form the Health Alliance for Violence Intervention. Data regarding respondent affiliation, programs, and perceptions of hospital policies outlining LE activity were collected. Follow-up video interviews were open coded and qualitatively analyzed using grounded theory. RESULTS Respondents from 32 HVIPs completed the survey (91%), and 22 interviews (63%) were conducted. Common themes from interviews were: police-patient interactions; racism, bias, and victims' treatment as suspects; and training and education. Only 39% of respondents knew that policies existed and were familiar with them. Most representatives believed their hospitals' existing policies were inadequate, ineffective, or biased. Programs that reported good working relationships with LE officers offered insight on how their programs maintain these partnerships and work with LE officers towards a common goal. CONCLUSIONS Unclear or inadequate policies relating to LE activity may jeopardize the health and privacy of violently injured patients. Primary areas identified for improvement include clarifying and revising hospital policies, education of staff and LE officers, and improved communication between health care providers and LE officers to better protect patient rights.
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Affiliation(s)
- Kate M Gallen
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael J Smith
- Georgetown University Law Center, Washington, District of Columbia
| | - Joshua Crane
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Carly Loughran
- Georgetown University Law Center, Washington, District of Columbia
| | - Kirsten Schuster
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, California
| | - Mildred Reese
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Vicki W Girard
- Georgetown University Law Center, Washington, District of Columbia
| | - Ji Seon Song
- University of California, Irvine School of Law, Irvine, California
| | - Erin C Hall
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, District of Columbia.
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13
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HIPAA and video recordings in the clinical setting. Nursing 2023; 53:15-19. [PMID: 36573862 DOI: 10.1097/01.nurse.0000902940.51519.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT The advent of cellular network technology has increased the use of photography in the clinical setting. This article reviews several areas regarding protected health information (PHI) and the use of video: the 1996 Health Insurance Portability and Accountability Act (HIPAA); The Joint Commission requirements for the use of images; areas of concern for exchanging PHI with law enforcement at the bedside, and the need for the development of formal guidelines regarding the use of video in the clinical setting.
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Hawkins BE, Coupet E, Saint-Hilaire S, Dodington J. Trauma-Informed Acute Care of Patients With Violence-Related Injury. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18376-NP18393. [PMID: 34463589 DOI: 10.1177/08862605211041375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.
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Alur R, Hall E, Khatri U, Jacoby S, South E, Kaufman EJ. Law Enforcement in the Emergency Department. JAMA Surg 2022; 157:852-854. [PMID: 35857315 DOI: 10.1001/jamasurg.2022.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rucha Alur
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erin Hall
- Surgical Intensive Care Unit, MedStar Washington Hospital Center, Washington, DC
| | - Utsha Khatri
- Emergency Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Sara Jacoby
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Eugenia South
- Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadephia
| | - Elinore J Kaufman
- Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Bliton JN, Zakrison TL, Vong G, Johnson DA, Rattan R, Hanos DS, Smith RN. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents. J Am Coll Surg 2022; 234:1238-1247. [PMID: 35703822 DOI: 10.1097/xcs.0000000000000183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
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Affiliation(s)
- John N Bliton
- From the Wellstar Atlanta Medical Center, Atlanta, GA (Bliton)
| | - Tanya L Zakrison
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Gerard Vong
- Emory University, Center for Ethics, Atlanta, GA (Vong)
| | - Dwane A Johnson
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL (Rattan)
| | - Dustin S Hanos
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
| | - Randi N Smith
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
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17
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Caballero E, Gutierrez R, Schmitt E, Castenada J, Torres-Cacho N, Rodriguez RM. Impact of Anti-Immigrant Rhetoric on Latinx Families' Perceptions of Child Safety and Health Care Access. J Emerg Med 2022; 62:264-274. [PMID: 35016793 DOI: 10.1016/j.jemermed.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Political rhetoric from the former U.S. president influences Latinx adults' feelings of safety and their decisions to seek care in the emergency department (ED). OBJECTIVE Our aim was to examine the impact of political rhetoric on feelings of safety and health care access in the pediatric population. METHODS This was a cross-sectional study of undocumented Latinx families (ULF), Latinx U.S. citizen families (LCF), and non-Latinx U.S. citizen families (NLF) conducted from November 2018 through February 2020 by means of interviewing a convenience sample of parents and guardians who brought their child to a pediatric clinic and two EDs in California. RESULTS Of 705 parents approached, 449 (63.7%) agreed to participate: 138 ULF, 150 LCF, and 158 NLF. Most ULF (95%), LCF (88%), and NLF (78%) parents and guardians had heard anti-immigrant statements from the former U.S. president and most (94% ULF, 90% LCF, 86% NLF) believed these measures against immigrants were being enacted or will be enacted. More ULF (75%, 95% confidence interval [CI] 67-81%) reported that these statements made them concerned about their child's safety in the United States compared with 36% (95% CI 28-45%) and 34% (95% CI 26-43%) of LCF and NLF, respectively. More ULF 17% (95% CI 11-24%) said that these statements made them afraid to bring their child for medical care, compared with 5% (95% CI 2-10%) and 3% (95% CI 1-7%) of LCF and NLF, respectively. CONCLUSIONS Most parents heard statements against undocumented immigrants by the former U.S. president and most believed measures were being enacted. This rhetoric had a substantial negative impact on ULF parents in terms of safety concerns for their child and fear of accessing health care.
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Affiliation(s)
- Elodia Caballero
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Raul Gutierrez
- Department of Pediatrics, University of California San Francisco, Zuckerberg San Francisco General Children's Health Center, San Francisco, California
| | - Eric Schmitt
- Department of Emergency Medicine, University of California San Francisco, Fresno, California
| | - Jannet Castenada
- Department of Emergency Medicine, University of California San Francisco, Fresno, California
| | - Natalie Torres-Cacho
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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18
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An Ethical, Legal, and Structural Framework for Law Enforcement in the Emergency Department. Ann Emerg Med 2021; 78:749-751. [PMID: 34756450 DOI: 10.1016/j.annemergmed.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 11/22/2022]
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19
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Policed Patients: How the Presence of Law Enforcement in the Emergency Department Impacts Medical Care. Ann Emerg Med 2021; 78:738-748. [PMID: 34332806 DOI: 10.1016/j.annemergmed.2021.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We sought to examine how physicians understand the role of law enforcement in the emergency department (ED) and to identify how the presence of law enforcement officers may impact the delivery of emergency medical care. METHODS In this qualitative study, we conducted semistructured interviews with 20 emergency physicians practicing in county EDs across 3 health care systems in Northern California between November 2017 and September 2018. Participants were recruited using snowball sampling and included 10 board-certified physicians and 10 resident physicians. We analyzed the interview content using grounded theory, where concepts from interview data were coded, grouped by theme, and compared over consecutive interviews to identify recurrent themes. RESULTS Participants reported interacting frequently with law enforcement officers while treating patients. Most participants characterized their experiences with law enforcement as "mixed" or "variable." Positive interactions with officers, who were described as helpful and collegial, contrasted with instances in which respondents felt police presence led to interruptions in treatment, breaches in health privacy, and potentially diminished patient trust. Participants reported that, at times, the authority of officers in the ED felt unclear and ill-defined, leading to contentious interactions between officers and health care personnel. CONCLUSION Lack of clear definition of the role of law enforcement officers in the ED may lead to contentious interactions with emergency physicians. Further research on the medical impacts of police presence in health care settings and on best practices for mitigating negative impacts is needed.
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20
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O'Neill KM, Salazar MC, Vega C, Campbell A, Anderson E, Dodington J. "The cops didn't make it any better": Perspectives on police and guns among survivors of gun violence. Soc Sci Med 2021; 284:114197. [PMID: 34274710 DOI: 10.1016/j.socscimed.2021.114197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Survivors of gun violence in the United States (US) are twenty times more likely to be re-injured with a firearm and three times more likely to be arrested under a violence or a weapons-related charge. The mechanisms for these outcomes are multifactorial and remain largely understudied. We aimed to examine perspectives on both the police and guns among survivors of guns violence. METHODS We conducted a secondary analysis of qualitative data from a study that examined the post-hospitalization recovery experience of survivors of firearm violence. Using a conceptual framework derived from sociology literature and a coding team made up of researchers, community members and former police officers, we used directed content analysis to construct themes. RESULTS The data set included interviews with 20 survivors of gun violence that were all Black males, aged 20-51 years. The recurring themes around the police included: (1) Legal cynicism: "I don't like police, none of them"; (2) Interactions with the police in a medical setting: "The cops didn't make it any better" and (3) Ambivalence around police presence within the community: "That's their job to protect me, too." Themes related to guns in the community encompassed: (1) The availability of guns: "Getting a gun is about as easy as buying a pair of sneakers"; (2) Symbolic meaning: "Guns give them courage"; (3) Social meaning: "I just let them know: I have a gun, too." and (4) Strategic meaning: "It's just for protection." CONCLUSIONS Survivors of gun violence describe distrust for the police and an ecology of guns that confers symbolic, social and strategic meaning to owning a gun. Interventions to decrease gun violence should address the cultural value of a gun as well as focus on improving police relations with the community.
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Affiliation(s)
- Kathleen M O'Neill
- General Surgery Resident, Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA; Investigative Medicine Program, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Michelle C Salazar
- General Surgery Resident, Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA; National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Cecilio Vega
- Violence Intervention Program, Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Anthony Campbell
- Yale Police Department, Yale University, New Haven, CT, 06510, USA
| | - Elijah Anderson
- Sterling Professor of Sociology and of African American Studies, Department of Sociology, Yale University, New Haven, CT, 06510, USA
| | - James Dodington
- Violence Intervention Program, Yale New Haven Hospital, New Haven, CT, 06510, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06510, USA
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21
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Ellis K, Walters S, Friedman SR, Ouellet LJ, Ezell J, Rosentel K, Pho MT. Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting. FRONTIERS IN SOCIOLOGY 2020; 5:593925. [PMID: 33869521 PMCID: PMC8022503 DOI: 10.3389/fsoc.2020.593925] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/16/2020] [Indexed: 05/05/2023]
Abstract
Background: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing morbidity and mortality, particularly in rural settings where resources may be limited. Methods: We conducted 20 semi-structured interviews with people who use drugs, including 17 who inject drugs, in rural southern Illinois between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data. Results: Participants reported breaches of trust by healthcare providers, often involving law enforcement and Emergency Medical Services, that dissuaded them from accessing medical care. Participants described experiences of mistreatment in emergency departments, with one account of forced catheterization. They further recounted disclosures of protected health information by healthcare providers, including communicating drug test results to law enforcement and sharing details of counseling sessions with community members without consent. Participants also described a hesitancy common among people who use drugs to call emergency medical services for an overdose due to fear of arrest. Conclusion: Breaches of trust by healthcare providers in rural communities discouraged people who use drugs from accessing medical care until absolutely necessary, if at all. These experiences may worsen healthcare outcomes and further stigmatize this marginalized community. Structural changes including reforming and clarifying law enforcement's role in Emergency Departments as well as instituting diversion policies during arrests may help rebuild trust in these communities. Other possible areas for intervention include stigma training and harm reduction education for emergency medicine providers, as well as developing and implementing referral systems between Emergency Departments and local harm reduction providers and medically assisted drug treatment programs.
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Affiliation(s)
- Kaitlin Ellis
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Samuel R. Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Lawrence J. Ouellet
- COIP/Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Jerel Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, United States
| | - Kris Rosentel
- Section of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
| | - Mai T. Pho
- Section of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
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Abstract
This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.
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Affiliation(s)
- Joseph H Kahn
- Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA.
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23
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Jacoby SF, Richmond TS, Holena DN, Kaufman EJ. A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race. Soc Sci Med 2018; 199:115-122. [PMID: 28552292 PMCID: PMC5694382 DOI: 10.1016/j.socscimed.2017.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/13/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
Patients with traumatic injuries often interact with police before and during hospitalization, particularly when their injuries are due to violence. People of color are at highest risk for violent injuries and have the poorest outcomes after injury. The purpose of this study was to describe how injured, Black patients perceived their interactions with police and what these perceptions reveal about police involvement within trauma care systems. We combined data from two qualitative studies to achieve this aim. The first was ethnographic fieldwork that followed Black trauma patients in the hospital through the physical and emotional aftermath of their injuries. The second was a qualitative, descriptive study of how patients experienced trauma resuscitation in the emergency department (ED). Both studies were conducted between 2012 and 2015 at the Trauma Center at Penn, an academic medical center in Philadelphia, Pennsylvania, United States. The present study includes data from 24 adult, Black participants undergoing treatment for injury. We reanalyzed all interview data related to law enforcement encounters from the scene of injury through inpatient hospitalization and coded data using a constant comparative technique from grounded theory. Participants described law enforcement encounters at the scene of injury and during transport to the hospital, in the ED, and over the course of inpatient care. Injured participants valued police officers' involvement when they perceived that officers provided safety at the scene, speed of transport to the hospital, or support and information after injury. Injured participants also found police questioning to be stressful and, at times, disrespectful or conflicting with clinical care. Communities, trauma centers, and professional societies have the opportunity to enact policies that standardize law enforcement access in trauma centers and balance patients' health, privacy, and legal rights with public safety needs.
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Affiliation(s)
- Sara F Jacoby
- University of Pennsylvania Perelman School of Medicine, USA; University of Pennsylvania School of Nursing, USA
| | | | | | - Elinore J Kaufman
- University of Pennsylvania Master of Science in Health Policy Program, USA.
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24
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Baker EF, Moskop JC, Geiderman JM, Iserson KV, Marco CA, Derse AR. Law Enforcement and Emergency Medicine: An Ethical Analysis. Ann Emerg Med 2016; 68:599-607. [PMID: 27157455 DOI: 10.1016/j.annemergmed.2016.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 11/26/2022]
Abstract
Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law.
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Affiliation(s)
- Eileen F Baker
- Riverwood Emergency Services, Inc., Perrysburg, OH, and the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH.
| | - John C Moskop
- Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joel M Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, and the Center for Healthcare Ethics, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Catherine A Marco
- Department of Emergency Medicine, Kettering Medical Center, Kettering, OH
| | - Arthur R Derse
- Center for Bioethics and Medical Humanities, Institute for Health and Society, and the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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